Bisphosphonate-related osteonecrosis of the maxilla and sinusitis maxillaris.

Bisphosphonates (BPs) are widely used as bone-stabilizers, but side effects of BP therapy include bisphosphonate-related osteonecrosis of the jaw (BRONJ), which is resistant to therapy. The aim of this study was to evaluate the outcome of maxillary BRONJ involving sinusitis maxillaris. 21 patients presenting with maxillary BRONJ, from 2005 to 2008, were included in the study. In 18 cases BP had been administered for carcinoma and in 3 cases for osteoporosis, with an average exposure time of 47.4 months. 12 patients spontaneously developed BRONJ. The 10 patients diagnosed with stage III BRONJ presented with concomitant sinusitis maxillaris. Despite treatment, there were six recurrences of BRONJ, four of them with additional sinusitis maxillaris. Whether BRONJ occurred spontaneously or after extraction there was no difference in the outcome. Patients with advanced maxillary BRONJ often suffer from sinusitis maxillaris, both of which are frequently resistant to therapy.

Functional and radiographic long-term results after bad split in orthognathic surgery.

Bilateral sagittal split osteotomy (BSSO) is a standard procedure in orthognathic surgery. The aim of the present study was to perform a matched pair analysis (bad sagittal split versus regular sagittal split) regarding the functional and radiographic long-term results after BSSO. Of 110 cases of mandibular hypoplasy treated with BSSO, 7 cases of bad sagittal splits (Group A) were selected, clinically examined and matched to 7 cases where no bad split occurred (Group B). The Research Diagnostic Criteria for Temporo Mandibular Disorders (RDC/TMD), condylar morphology scale (CMS) and ramus height measurements using orthopantomograms were carried out in the follow-up period to observe the clinical and functional status and condylar resorbtion or remodelling. The mean follow-up time was 28.6 months. The RDC/TMD examination did not show a higher incidence of temporomandibular dysfunction, including pain or clicking in the bad split group. Patients without a bad split showed statistically significant (p<0.05) better mouth opening. The CMS measurements were comparable in both groups. When compared with regular splits, bad splits, if treated in an appropriate manner, have a good chance of functional success, although, some mandibular movements can be compromised.

Bisphosphonate-related jaw necrosis--severe complication in maxillofacial surgery.

Bisphosphonates are used as potent inhibitors in metastatic bone lesions. They can reduce skeletal burden and prevent bony metastases. They are integral in the treatment of some tumours like breast cancer, prostate cancer and multiple myeloma. As a side effect, these drugs also may cause severe jaw necrosis. Twenty-four patients with bisphosphonate-related jaw necrosis were analyzed in a clinical study. These necroses mostly appeared after administration of aminobisphosphonates. Recurrent avascular necroses were found after changing from Pramidronate to Zoledronate. All patients were treated by resection of necrotic bone. Repeated surgical interventions were required with about 25% of the patients. The management of patients with bisphosphonate-related jaw necrosis remains extremely difficult and includes surgical procedures as well as the eradicating of the necrotic bone including antibiotic therapy. The prevention of such complications consists in a minimization of dental surgical interventions and an avoidance of ulcers by dental prosthesis.

[Eagle's syndrome: a rare cause of facial pain and difficulties in swallowing]. / Eagle-Syndrom: Eine seltene Ursache für Gesichtsschmerzen und Schluckbeschwerden.

A 47-year-old patient suffered from right-sided facial pain in the chin and lower cheek, hyperpathia, and difficulties in swallowing. The diagnosis of Eagle's syndrome was based on digital palpation of the bilaterally elongated styloid process and radiography. Eagle's syndrome should be considered in patients with difficulty swallowing, masticatory pain, globus sensation, and neuropathic pharyngeal or facial pain. If conservative therapy fails, selected patients may benefit from surgical excision of elongated styloid processes if pain relief by local anesthesia is proven.

Morphological analysis and chemical content of natural dentin carious lesion zones.

Dentin is one of the earliest bio-mineralization products to appear in the evolution of vertebrates. Dentin reactions to infection mimic earlier phylogenetic patterns, and carious lesions are divided into different zones which reflect the natural patho-morphological reaction of dentin to the carious attack. It was the aim of this study to investigate deep dentin carious lesions of human molars with combined polarization light microscopy, scanning electron microscopy and energy dispersive X-ray element analysis (EDX) for the determination of different zones of the carious lesions, their extent and the chemical content. Sixteen extracted teeth with deep dentin carious lesions were embedded in Technovit 9100 (Kulzer) and serial sections of 80 microm thickness were made. These sections were then examined with polarized light microscopy to identify the different zones of the lesions. The outlines of the zones were traced consecutively and 3D-reconstructions were made for the determination of the extent and calculation of the volumes of the different zones. From the volumes of the demineralizing dentin and the translucent zone a Dentin Demineralization Index (DDI) was calculated. Three sections of each lesion were then coated with carbon and studied with a scanning electron microscope. 3D-reconstruction of the teeth showed the rather stable translucent zone, interrupted by remnants of dead tracts, and very different volumes of demineralizing dentin. Therefore, with increasing size of the demineralizing dentin, the DDI increased. The chemical content was measured using energy dispersive X-ray analysis (EDX) in areas of intertubular dentin. The content of Ca, P, and C was significantly different in all zones. The Ca/P ratio was significantly different between sound dentin and demineralizing dentin. From the results we conclude that the mineral content of intertubular dentin of the translucent zone and demineralizing dentin is different from that of sound dentin, and the unique mineralization pattern of the translucent zone is a biological reaction to the carious attack. Because active dentin lesions exhibit many non-occluded open dentin tubules, further bacterial invasion or, in case of dentin treatment, the penetration of bonding agents towards the pulp is morphologically not prevented and therefore of clinical importance.